Register

Course information.

All fields marked * are required.

Course*
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8-week MSC Dates*

Please select the dates required

8-Week MSC Term 4 - Cumberland Park*

Please make your selection

5-day MSC dates*

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MSC Free information session 13th of August*

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MSC 5 Day Intensive, 28th September to 1st October 2018

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Retreat Day dates*

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Retreat Day Saturday 6th October 2018*

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Retreat Day Saturday 15th December 2018*

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MSC: Inner Resilience - 20th of October, 10am - 4pm*

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Creating Balance - 3rd of November, 10am till 4pm*

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Registration Data

First Name*
Please let us know your first name.

Last Name*
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Age (Optional)

Contact Number*
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Preferred contact time
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Your Email*
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Postcode

Do you have any special conditions to be catered for (e.g. dietary, accessibility, etc.)?

Payment Details

Fee type*
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Fee type*
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Preferred payment option *
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If you are applying for a concession rate, please share a little about your current circumstances

Further Information only for MSC Programs

If you are registering for a retreat day or workshop, this information is not required.

What interests you about the program and what are you hoping to gain?

Can you make the commitment to attend all sessions?
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Can you make the commitment to practice the mindfulness and compassion skills in between each session?
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Compassionate Choices

I agree to print and complete the following Compassionate Choices form
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Click here to download the form.

Emergency contact name and mobile number.

Please share details of any previous meditation experience

Please note any current mental health problems or significant life issues you are experiencing

If so, are you under the care of a mental health practitioner?
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Additional Information

Are you happy to subscribe to our quarterly newsletter?
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How did you hear about Adelaide Mindfulness?

Please include any comments or questions you may have

Privacy Policy & Terms and Conditions

We value our community and ensure the data we collect is handled sensitively, securely, and with due regard for personal privacy. We will not release your email address or personal information to any other party.

Submission of this registration form is not confirmation of your position in the program/ workshop. We will be in touch with you shortly to confirm your place and discuss payment details.

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